Question

1. Identify:
   1. a) types of third party plans
   2. b) information required to file a third-party claim
   3. c) the steps for filling a third-party claim

2. Describe processes for:
   1. a) verification of eligibility for services
   2. b) precertification
   3. c.) preauthorization
3. Outline managed care requirements for patient referral ?

Answer 1

ANSWERS :

a. a) TYPES OF THIRD PARTY PLANS :

* Medicare

* High deduct health plan (HDHP)

* Point of service plan (POS)

* Health maintainance organization (HMO)

b. b) INFORMATION REQUIRED TO FILE A THIRD PARTY CLAIM :

* Collect all the required information or documents to file a claim

* Report a file on accident

* Get notify to the other driver side with registry numbers of claim if needed

* Notify to other driver insurance company as early as possible

* Submit the required documents or paper work to the insurance company

* Be cooperative with investigators conducted by insurance company

* Showing and submitting of all the proofs and bills to the investigation department

* Once the claim has approved by the insurance company then compensate

c. c) STEPS FOR FILLING A THIRD PARTY CLAIM :

* Accident report should be reported to police

* Gather full details of the policy number and carrier of insurance company , full name, address, phone number, drivers licence, driving licence

* Collect correct information from the other driver without fail

* Approach for the specialized person in third party claiming cases

* Take sign or address of the witnessed person

* Write down detailed notes of accident, if possible click photographs of accident zone as a evidence basis

* Carefully keep bills and receipts for further purposes

* Wait for the decision of the insurance company.